Healthcare Provider Details

I. General information

NPI: 1568654721
Provider Name (Legal Business Name): KIMBERLY ANN UJAH R.D., L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 W BROAD AVE
FLANDREAU SD
57028-1630
US

IV. Provider business mailing address

124 CRAIG CT
BROOKINGS SD
57006-4657
US

V. Phone/Fax

Practice location:
  • Phone: 605-997-2642
  • Fax: 605-573-0943
Mailing address:
  • Phone: 479-719-2840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1155
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: